Legislative Initiatives

In an effort to help the public and lawmakers understand the unique role of the emergency department team and to bolster support to overcome the many challenges we face, ACEP launched a campaign in May 2013 called “Saving Millions.” The campaign includes a series of print ads, radio messages and coordinated editorials in influential communications nationwide. To learn more, click on the “Saving Millions” banner above.

Letter from Hawaii ACEP President-Elect

Dear Hawaii ACEP members,

In the 2013 Hawaii legislative session, a bill was introduced that would have legislated how opioid medications can be prescribed from emergency departments. Specifically, it would have:

1.Prohibited long-acting pain relievers from being prescribed from emergency departments.2.Prohibited prescribing more than a three-day supply of opioid medication from emergency departments.3.Prohibited refilling prescriptions of lost, stolen, or destroyed opioid medications by emergency departments.

Other state and city governments have issued opioid prescribing guidelines (e.g. New York City and Utah). Hawaii’s legislation would have been the first that mandated how opioids are prescribed. While the bill failed to pass, we have been warned that it may return because the problem is considered so great.

Fair or not, opioid prescriptions from the emergency department are under the microscope in Hawaii and nationally. While emergency physicians issue only 5% of opioid medication prescriptions, legislators and the public have focused on the emergency department as a place where inappropriate prescriptions for opioid medications are common.

With that in mind, the Board of Directors of Hawaii ACEP has created guidelines for opioid use in treating non-palliative, non-cancer pain in Hawaii’s emergency departments. We have two goals: (1) To demonstrate to the public and the legislature our commitment as emergency physicians to appropriately administering and prescribing opioid medications in Hawaii’s emergency departments, and (2) to create a document emergency physicians can use to discuss appropriate opioid use with their patients.

Paternalism is not our intention. We on the Board are all practicing emergency physicians and care deeply about our ability to appropriately care for our patients. As with any set of guidelines, the needs of the individual patient outweigh the need to conform to guidelines. All of us care for patients who require opioid use ‘outside’ of these guidelines. We as clinicians have discretion based on our clinical judgment. However, we believe that these are general guidelines that the majority of emergency physicians already use in caring for most patients. These guidelines will not apply to every patient, but we believe they apply to the majority of patients receiving opioid medications in Hawaii’s emergency departments.

For many reasons, appropriate medical care cannot and should not be legislated. Our guidelines are a means to avoid further attempts at legislation and also a way to help emergency physicians talk with their patients about opioid medications. We feel this is an important way Hawaii ACEP can help to improve medical care in Hawaii.

Other Legislative Initiatives

Hawaii ACEP represents the rights and interests of our members and patients in the state capitol of Honolulu. As a strong and unified medical specialty organization, we lobby for numerous legislative initiatives to empower emergency physicians and protect our patients.

Recent activities include support of emergency physician tax credit legislation, as well as multiple pieces of legislation that mandate transparency in the allocation of health insurance premiums by insurance companies. Some of the most exciting legislative news in recent years pertains to a new tax credit for emergency physicians who work a minimum of 576 on-call hours in a state-approved emergency room. Here are the details:

Emergency room physician tax credit.

(a)There shall be allowed to each qualified taxpayer subject to the taxes imposed by this chapter, an emergency room physician tax credit that shall be applied to the qualified taxpayer’s net income tax liability, if any, imposed by this chapter for the taxable year in which the credit is properly claimed.

(b)As used in this section, “qualified taxpayer” means a physician licensed under chapter 453 and who:

(1)Works as an emergency room physician in a state-approved hospital emergency room on an on-call basis;(2)Has worked a minimum of five hundred and seventy-six on-call hours in the year for which the tax credit is claimed; and(3)Does not owe the State delinquent taxes, penalties or interest.

(c)The tax credit shall be in an amount equal to five per cent of the amount of medical malpractice insurance premium paid by the qualified taxpayer for the taxable year in which the credit is claimed.

(d)If the tax credit claimed by the qualified taxpayer under this section exceeds the qualified taxpayer’s income tax liability, the excess of credit over liability shall be refunded to the qualified taxpayer; provided that the tax credit properly claimed by a qualified taxpayer who has no income tax liability shall be paid to the qualified taxpayer; and provided further that no refunds or payments on account of the tax credit allowed by this section shall be made for amounts less than $1. This Act, upon its approval, shall apply to taxable years beginning after December 31, 2009.

ACEP Looking for Volunteers for Advocacy Efforts on the Federal Level

Are you a member of ACEP’s 911 Legislative Network?

ACEP established the Network in 1998 to encourage emergency physicians to cultivate long-term relationships with federal legislators, convey ACEP’s legislative and regulatory priorities-in an effective manner, and influence the final outcome of federal legislation important to the specialty of emergency medicine. There are now nearly 1400 ACEP members participating, 10 from our state.

In 2009, when Congress tackled legislation to overhaul our healthcare system, ACEP recognized that it is more important than ever for emergency physicians to have a role in shaping federal health care policy on behalf of our patients and our specialty.

To further advance the work of the Network, our chapter has been asked by ACEP to identify a “State Leader” for the 911 Network who will coordinate federal advocacy efforts within our state and communicate information and action items from ACEP on federal legislation back to our chapter members.

If you are interested in serving as our State Leader, please contact Jeanne Slade in the ACEP Washington, DC office at 800-320-0610, ext 3013.